Vascular Perforation And Central Venous Catheters

Using a central venous catheter can cause damage to the surrounding structures if not done properly. For example, vascular perforation can occur when the catheter tip is misplaced. Fortunately, however, vascular perforation is an unusual complication. Only 10% of perforations occur in central veins.

When this happens, it is usually only diagnosed too late. So it can be dangerous. For this reason, we want to explore this problem in more detail in this article and how it can be detected.

Types of central venous catheters

These catheters are designed to reach the largest central vein near the heart. Catheters vary in size, length, and number of channels depending on the purpose for which they are intended.

These are the main types of central venous catheters:

Peripheral central catheter

It is a long catheter that extends from a vein in the arm or leg to the largest vein near the heart. It is also called a “centerline catheter” when it is inserted in such a way that the tip of the catheter remains in a relatively large vein. However, it does not extend into a larger vein.

Tunnelless catheter

The tunnelless central catheter may consist of a larger caliber and is intended to be placed in a relatively large vein. Such a central vein may be in the neck or thigh.

Tunnel catheter

This may include a cuff that stimulates tissue growth, helping it to stay in place in the body.  There are different sizes and types of tunnel catheters. Their safety and ease of use are their main features.

Portic catheters

It is a permanent device consisting of a catheter connected to a small reservoir.

Risk of vascular perforation

The diagnostic test chosen for vascular perforation at the central level is computed tomography.

There are two types of risk directly related to the use of a central arterial catheter:

• Risks that occur during installation.
• Risks associated with the device in the body.

Some of these risks include:

• Infection at the incision site soon after catheter insertion.
• Risk of bleeding.
• Air chest or accumulation of air in the chest, which can lead to lung constriction. This may occur when the catheter is inserted into a vein in the chest or neck. However, it does not occur with the veins in the arm.
• The catheter may sometimes enter an artery instead of a vein. If this happens, your doctor will need to remove it. Most often, the artery then heals on its own, but it sometimes requires surgery.

Infection due to vascular perforation

There are two types of late infections that can occur with a central artery catheter:

• Skin infection in the catheter insertion opening.
• Infection in the bloodstream.

When a catheter is not properly inserted into the skin by a person skilled in the art, it is possible that it will accidentally come out. If this happens, the  incision should be pressed with a sterile bandage and the doctor should be told immediately.

All central arterial catheters can become blocked by a blood clot. The clot can be treated with blood thinners, but sometimes the catheter needs to be removed.